P - 78953REQUEST FOR ELECTRICAL INSPECTION
1— 6 5 7��� o � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAiR Describe -using the back of the white copy if necessary - the woric covered by this request:
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GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Am re $25
401 to 800 Am re E50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere p$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li h6n Retrofit $.25 r Fixture
Center Pivot Irtiaafbn Boom �$40 A 1 ��
I��I) IIIII I��II II��� III�I �I�II I�III �IIII �� I�
1657
Outdoor Li hti� Siandard $1 _
Trafic Si nal Standard $5
Su demental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I OuUine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �>
(minimum total fee is $20) �z --
TMSNiEAFORiNSPECiIXil15E01�4v �
I hereby certify that I inspecled the electric� installation described herein on the dales sU6ed:
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Request Date: Roughin Inspecfion Ftequirad? Yes No InspeGion O�her Than R�uSMn: Ready Now ❑ M411 Call
Yau must cell the inspector when readyl pete Ready
I ce►tify �at I am tlie �►CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of U�e electricai work at;
—'" _—� ' oa,nw ur r�� i wciiv CoaY E&00001M14 8.1. 2002